Research ArticleCancer Diagnostics

Intraoperative Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry

Science Translational Medicine  17 Jul 2013:
Vol. 5, Issue 194, pp. 194ra93
DOI: 10.1126/scitranslmed.3005623

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Diagnosing the Masses

One of the best options for curing cancer is surgery. Yet, surgeons can leave cancerous tissue behind by not seeing the “tumor margins”—or edges of the tumor—clearly. If a surgeon isn’t sure whether tissue is normal or cancerous, the tissue is sent to a pathologist for testing. During this time (20 to 30 min), the patient remains under anesthesia, and, quite often, additional samples are required. To ensure that all malignant tissue is removed in the operating room, Balog and colleagues developed a mass spectrometry–based approach that identifies cancer during surgery.

After analyzing ex vivo samples of cancerous, healthy, and benign/inflammatory tissue with rapid evaporative ionization mass spectrometry (REIMS), the authors created a database of the nearly 3000 tissue-specific mass spectra. These spectra were unique for each cancer type, with lipids such as phosphatidylcholine and phosphotidylinositol showing different ratios. Using these ratios, Balog et al. were even able to identify the origin of metastatic tumors ex vivo.

To adapt this technology for use in vivo, during surgery, the authors created the “intelligent knife” (iKnife), which samples surgical smoke for mass spectrometric analysis. More than 800 spectra were acquired with the iKnife from 81 patients. These spectra, when matched against the previously created database, confirmed the results of normal histology, with low rates of false-positive and false-negative readouts. This first-in-human demonstration shows that the iKnife technology is ready for widespread use in the operating room to improve the accuracy of surgical intervention in cancer.